{"id":16735,"date":"2025-06-05T21:19:29","date_gmt":"2025-06-05T21:19:29","guid":{"rendered":"https:\/\/wifamily.news\/?p=16735"},"modified":"2025-06-05T21:58:33","modified_gmt":"2025-06-05T21:58:33","slug":"at-center-of-americas-essential-debate-johnson-says-resist-spending-frenzy","status":"publish","type":"post","link":"https:\/\/wifamily.news\/?p=16735","title":{"rendered":"At center of America\u2019s essential debate, Johnson says resist spending frenzy"},"content":{"rendered":"

This post originally appeared at https:\/\/www.badgerinstitute.org\/at-center-of-americas-essential-debate-johnson-says-resist-spending-frenzy\/<\/a><\/p>\n

Laments Medicaid\u2019s \u2018legalized fraud\u2019 and says childless adults should work<\/strong><\/em><\/h4>\n

The U.S. Senate has an opportunity to slow the growth of Medicaid, something that hasn\u2019t been seriously tried for decades, Sen. Ron Johnson says.<\/p>\n

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Miss it, and Wisconsin and nine other states are at serious risk of caving to political pressure, expanding their Medicaid programs, and setting off a frenzy of spending on the fastest growing welfare program in the country, the Wisconsin Republican says.<\/p>\n

\u201cThis is our moment, if we\u2019re ever going to do it,\u201d he says. \u201cWe have to be clear about what we\u2019re doing, and we have to keep it simple.\u201d<\/p>\n

Part of the budget reconciliation bill that narrowly passed the House of Representatives last month is a recommendation for reforms projected to reduce the growth in Medicaid spending by least $720 billion over the next 10 years. The savings would be achieved in part by curbing a system of state taxes on health care providers and federal reimbursement that Johnson has called nothing less than a money laundering scheme. The other component is requiring millions of childless adults on Medicaid, a program intended for the poor, to get jobs.<\/p>\n

Johnson has been the leader calling on the Senate to add a line-item review of the Medicaid budget. The fiscal conservative knows the inner workings of Medicaid as well as anyone in Congress.<\/p>\n

Often in his three terms in the Senate, he has been a lone voice<\/a> railing against the $543 billion in improper Medicaid payments<\/a> disbursed, according to the Office of Management and Budget, from 2015 through 2024. The reconciliation bill has turned his attention to the addition through Obamacare of more than 21 million people to the Medicaid rolls, and the provider tax provision.<\/p>\n

\u201cThe provider tax loophole is designed for state governments to fleece the federal government,\u201d Johnson told the Badger Institute late last week. \u201cWe know where the abuse is. It\u2019s legalized fraud. Let\u2019s call it what it is.\u201d<\/p>\n

Predictably, the legacy media have spent little time examining the waste, fraud and abuse and instead focused on a narrative of lost funding and services, something the Wall Street Journal editorial board<\/a> called \u201cThe Medicaid Scare Campaign.\u201d<\/p>\n

The Congressional Budget Office estimated<\/a> the reconciliation bill would reduce Medicaid spending by an average of $72.3 billion a year for 10 years. Enforcing work requirements would lead 7.6 million people, mostly single men, to drop off the rolls by 2034, the CBO estimated.<\/p>\n

A Wisconsin Department of Health Services impact study<\/a> in April based on the bill\u2019s original proposal for $880 billion in Medicaid cuts estimated that 52,000, or 27% of an estimated 191,000, childless adults would lose their coverage.<\/p>\n

\u201cWe expect about 63,000 individuals will get caught up in this new red tape of proving they are eligible and could potentially lose their Medicaid eligibility because of these new (work) requirements,\u201d said Wisconsin Medicaid Director Bill Hanna on the WisPolitics Capitol Chats podcast this week.<\/p>\n

The April study also estimated that the state could lose anywhere from $6.4 billion to $16.8 billion in federal funding over the next 10 years if the reconciliation bill includes a per-person limit on federal funding for Medicaid.<\/p>\n

The current bill calls for a freeze in the provider tax, not a cap or a reduction, although Johnson says there has been some discussion among fiscal conservatives in the Senate.<\/p>\n

The problem with such predictions of lost coverage is the assumption that so many childless adults would drop out of Medicaid and remain idle. House Speaker Mike Johnson, R-La., said this week the idea that work requirements are onerous isn\u2019t credible.<\/p>\n

As the Wisconsin DHS acknowledged in its report, the federal government already has a work requirement for those receiving benefits from the Supplemental Nutrition Assistance Program, or \u201cfood stamps.\u201d<\/p>\n

\u201cWork requirements should have been put in a long time ago,\u201d House Speaker Johnson said on a Sunday news program.<\/a> \u201cFour-point-eight million people will not lose their Medicaid unless they choose to do so.\u201d<\/p>\n

Lost in the debate is any question over the idea that able-bodied adults without dependents should be eligible for Medicaid in the first place, something never envisioned when Congress created the program in 1965.<\/p>\n

Passage of the Affordable Care Act, or \u201cObamacare,\u201d in 2010 allowed these adults to get Medicaid benefits with incomes as high as 38 percent above the federal poverty line. Those earning more would become eligible for other subsidized coverage under Obamacare. Previously, Medicaid was generally not available<\/a> to such adults in most states.<\/p>\n

The federal government backed this expansion by promising states it would pay 90 percent of the cost of such new recipients\u2019 coverage.<\/p>\n

Medicaid is funded by both states and the federal government, with the federal share of the cost for most recipients ranging from 50 percent to 77 percent<\/a>, depending on the state. In Wisconsin, the federal share is about 60 percent. That\u2019s why having to pay only 10 percent of the cost for those added to Medicaid was such a powerful incentive for states to expand their rolls.<\/p>\n

Wisconsin, however, already provided Medicaid to able-bodied childless adults with incomes under the poverty line, and under Gov. Scott Walker rejected the Obamacare expansion, deferring such adults with incomes above the poverty line to the subsidized Obamacare insurance exchanges.<\/p>\n

Gov. Tony Evers has included a package for Medicaid expansion in every one of his budget proposals. Republican majorities in the state Legislature have removed every one of them.\u00a0<\/p>\n

Senator Johnson says that refusal under Walker and since then has been wise.<\/p>\n

\u201cRepublicans in this state always anticipated that the federal gravy train would end and now that it has, we have some spending decisions to make,\u201d Johnson says.<\/p>\n

The outsized role of childless adults increased during a more than three year \u201chealth emergency\u201d declared and extended by President Biden long after the impact of COVID-19 had abated.<\/p>\n

At the onset of COVID in March 2020, overall Medicaid enrollment in Wisconsin was 1,187,838. At its peak in May 2023, enrollment had ballooned by 41.2 percent to 1,676,787.<\/p>\n

By May 2024, after federally mandated \u201cunwinding,\u201d enrollment had dropped to 1,351,059, a nearly 20 percent reduction from the peak, but 163,221 or 13.7 percent more people on the rolls than March 2020.\u202f<\/p>\n

Medicaid enrollment as of April is still 97,934 or 8.2 percent higher than the start of the pandemic. Department of Health Services officials have several times declined to explain those increases.<\/p>\n

Childless adults also hit an enrollment peak, 306,817, in May 2023, dropping to 188,072 in July 2024. However, unlike every other Medicaid category, enrollment of childless adults went back up every month to 197,808 in February before dipping to 194,305 in April, according to state data<\/a>.<\/p>\n

While Wisconsin DHS officials also declined to explain the trend, the math says childless adults are the most valuable bargaining chip in the state\u2019s Medicaid money laundering, as Paragon Health Institute called it in its study<\/a> in March.<\/p>\n

Paragon has gotten the attention <\/a>of the D.C. media with its studies of Medicaid waste and fraud. Senator Johnson makes frequent reference to its pithy but data-laden study of the provider tax.<\/p>\n

In the traditional funding split such as Wisconsin\u2019s, for every $100 in state funding, the federal government puts up $150, Niklas Kleinworth, co-author of the Paragon study, told the Badger Institute. For those added to Medicaid through the Obamacare expansion, $100 in state funding gets a $900 federal match.<\/p>\n

States are then allowed to levy a tax on hospitals and insurance companies to increase revenue available via a federal match, later returning some of that funding to the very entities being \u201ctaxed\u201d and keeping the rest.<\/p>\n

\u201cEveryone involved \u2014 hospitals, doctors, insurance companies and the states \u2014 has a perverse incentive,\u201d Kleinworth says. \u201cThe only people who don\u2019t benefit are the enrollees and the federal taxpayer. It\u2019s a shell game.\u201d<\/p>\n

Paragon has pointed out<\/a> in 2012-13 President Obama included curbs on provider taxes, supported by his vice-president, Joe Biden. President George W. Bush and President Trump in his first term called for provider tax reform.<\/p>\n

Congress refused to accept any of the proposals.<\/p>\n

Unless Congress does something substantive, Senator Johnson, who is optimistic, said the holdout states such as Wisconsin will interpret the lack of political will as an invitation to expand their Medicaid programs.<\/p>\n

\u201cThe message sent is, \u2018Why shouldn\u2019t we take the free money? Why should we be the chumps?\u2019\u201d Johnson says.<\/p>\n

Instead, the time is never better to keep resisting and reverse the insane spending, he says.<\/p>\n

Mark Lisheron is the Managing Editor of the Badger Institute.<\/em><\/p>\n

Any\u202fuse or reproduction of Badger Institute articles or photographs requires prior written\u202fpermission.\u202fTo request permission to post articles on a website or print copies for distribution, contact Badger Institute Marketing Director Matt Erdman at\u202f<\/em>matt@badgerinstitute.org<\/em><\/a>.<\/em><\/p>\n

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